Hypertension management in practice, 1986
Weidmann, P.
Schweizerische Medizinische Wochenschrift 116(46): 1592-1597
1986
ISSN/ISBN: 0036-7672 PMID: 2878492 Document Number: 273742
Persons with persisting (at least 3 measurements over several weeks) borderline blood pressure elevation or established hypertension should always be instructed to follow general non-pharmacological measures. Antihypertensive pharmacotherapy is recommended in the following situations: in hypertensive emergencies, immediately; if the hypertension is not due to a surgically remediable cause, in patients with documented (at least 3 measurements) blood pressure elevation to diastolic values greater than 100 mm Hg; in patients with "mild" hypertension (diastolic up to 104 mm Hg) which does not decrease to less than 160/95 mm Hg following 3 to 6 months of treatment with general non-pharmacological measures; in persons with borderline blood pressure values (141-159/91-94 mm Hg) that persist following 6 to 12 months of general measures and only if they have severe additional cardiovascular risk factors; in patients with pronounced isolated systolic hypertension (greater than 180 mm Hg). In elderly patients who are frail or have evidence of advanced cardiovascular disease, dementia or other debilitating illnesses, blood pressure-lowering drugs should generally be reserved for diastolic blood pressure values consistently exceeding 110 mm Hg. There have recently been important new developments in antihypertensive pharmacotherapy. Two new pharmacological principles, the calcium entry blockers and angiotensin converting enzyme (ACE) inhibitors, have been introduced widely into practical hypertension treatment. On the other hand, concern has arisen that the conventional, thiazide-diuretic based therapy, despite its established beneficial influence on blood pressure and most cardiovascular complications, may not significantly improve or may sometimes even adversely affect coronary prognosis because of metabolic side effects.